Maturing of public-private-people partnership (4P): Lessons from 4P for triple disaster and subsequently COVID-19 pandemic in Fukushima

www.jogh.org • doi: 10.7189/jogh.12.03028 1 2022 • Vol. 12 • 03028 Public-Private-People Partnership (4P) is a cross-sector collaboration combining “people” with a traditional Public-Private Partnership (PPP). The term “people” encompasses civil society organisations, academia, professional organisations, media, and others. 4P was proposed to compensate for the shortcomings in conventional PPPs regarding a lack of residents’ viewpoints, clarification of civil engagement, and incorporation of bottom-up strategies, especially in disaster management [1,2]. People – the 4th P – can provide the missing connection in traditional PPPs to strengthen the partnership further and achieve effective and integrated partnerships between multiple sectors [3].

ing from the triple disaster have also been affected by the COVID-19 pandemic. The COVID-19 pandemic is considered a disaster with capacity enhancement being one of the major challenges for disaster damage management. Here, 4P is considered an essential solution [6]. This area is suitable for reporting how experiences and knowledge of cross-sector collaboration regarding disaster response and recovery can help with preparing for unexpected disasters in communities.
The COVID-19 pandemic has also affected the Fukushima prefecture, where post-disaster recovery is ongoing. In this area, the Fukushima Vaccination Community Survey (FVCS) -a series of antibody testing against CO-VID-19 -is carried out under multi-sectoral collaboration between research agencies, universities, local governments, and the medical sector. Approximately 2500 residents in the radiation disaster-affected areas, where the population is aging due to radiation, are participating in the project. Antibody testing among medical personnel, patients, frontline workers, and the general public is being carried out every three months. Fukushima prefecture might be one of the fastest cohort setting areas for COVID-19 antibody testing in the Japanese community. There are many barriers to cross-sector collaboration during disasters, including economic, political, legal, structural, procedural, strategic, executive, human, socio-cultural, and sharing of information [4,6]. Nevertheless, FVCS could overcome these barriers immediately. This paper presents the experience and knowledge of disaster recovery in the region and how it helped in responding to the newly occurring disaster and developing countermeasures, including the FVCS, for CO-VID-19 under 4P (Figure 1).
The first key point is that some municipalities in Fukushima prefecture already have many years of experience with surveys on radiation exposure and related health issues in the disaster-affected area. Therefore, these municipalities could deal with ethical matters in research without any hurdle. The persons involved in FVCS have a shared sense of value that makes invisible health threats visible, since sharing the results with the residents is vital. This helped to overcome several barriers -legal, structural, procedural, human, and socio-cultural. The accumulated experience of joint research, conferences, and workshops for radiation health management with the collaboration of municipalities, universities, hospitals, and residents has clarified the aspects that might give rise to ethical issues. The experience of 4P with radiation disaster has been valuable in overcoming such issues effectively in the COVID-19 pandemic era.
The second key point is that the FVCS principal investigator has built trust over the years with key persons in the sectors. Presently, a better balance could be maintained by working across municipalities, which would help the project overcome political and human barriers. Three municipalities cooperated with the FVCS, with the key persons from each municipality being the mayor (also the director of the medical institution), the head of the health and welfare department in a municipal organisation, the hospital director, the hospital office manager, the municipal hospital's clinical director, and the head of a local medical association. Strong connections with the few key persons in the sectors who could make decisions and coordinate were essential. In this case, personal connections worked well instead of contracts and mere appearances.
The third key point was to expand cooperation to various sectors (based on key persons) such as hospitals (public and private) and health facilities, local government, several universities, media, local medical associ-  ty experienced a disaster, the community was required to deal with the issues, and the skills and relationship between sectors might be mature. When the next disaster happens, the community would overcome the barriers and make strategy smoothly.